The Idaho Senate approved a proposed state-based health insurance exchange on Thursday, after a debate in which it was alternately bashed as federal tyranny and praised as protecting Idaho's sovereignty.
"It was very emotional debate today on the floor," said Sen. John Goedde, R-Coeur d'Alene. "There's no question that everyone that debated had their own perspective."
But Goedde, who served on a committee investigating the best implementation of the Affordable Care Act, was pleased to see the bill pass. He lauded improvements like increased accountability that the House had added to the legislation.
"If you posed the question to Idaho citizens whether they want a state exchange or federal exchange, the answer overwhelmingly is state exchange," Goedde said. "There still are individuals here who believe that somehow we can sit back and do nothing, and nothing will happen. I don't think that's within the realm of possibility."
The bill now goes to Gov. Butch Otter, who sponsored the measure and said he'll sign it into law.
After that, the real work begins with implementing the state-run online exchange by the Oct. 1 deadline, Goedde said.
"The advantage is we've got a number of states ahead of us, and my understanding is we can piggyback on all the work they've done," Goedde said, estimating that implementation will cost $20 million. "That helps."
Unlike two dozen Republican governors in other states, Gov. Otter backs such an exchange run by a state-created, nonprofit corporation. He argues it will be cheaper and more responsive to Idaho residents and better for insurers based in Idaho.
Sen. John Tippets, R-Montpelier, contended that adopting a state-run online marketplace for individuals and small businesses to buy insurance, rather than accepting a federal one, better protects Idaho from a single-payer system he fears is the ultimate goal of President Barack Obama's health insurance overhaul.
What's more, he said, the bill approved by a 23-12 vote includes provisions for Idaho to exit if courts eventually overturn the 2010 law. Many Idaho Republicans continue to hope that will happen, despite a June 2012 decision by the U.S. Supreme Court upholding its constitutionality.
"If that happens, we don't even have to take any actions to get out of this mess - it's already done right here," Tippets said. "I wish we could keep the Affordable Care Act from being enacted. I don't see any way."
The final vote was unchanged from the Senate's Feb. 21 tally on a similar bill.
Since then, the House has added requirements, including competitive-bidding for contractors seeking to run the exchange; gun-rights protections for participants; and an expanded, 19-member board that includes three legislators - two from the majority party and one from the minority - with voting rights. Its meetings would have to be streamed over the Internet, for the public to see. The revised bill was returned to the Senate, which had to consent to the changes.
Rep. Luke Malek, R-Coeur d'Alene, voted in favor of the bill last week in the House.
"I certainly believe the state being involved is a far better option and better for our state sovereignty than allowing the feds to take over our market," Malek told The Press.
On Thursday, foes of the exchange acknowledged they were unlikely to alter last month's vote but still spent about three hours trying.
Sen. Russ Fulcher, R-Meridian, predicted adopting a state exchange would attach Idaho to the strings of "the federal puppeteer." Such a relationship would eventually have to be undone after people realize it's too expensive and begins to collapse under its own administrative weight.
"My heart, my mind and my soul believes that this is the wrong thing for Idaho," Fulcher said.
Otter, a Republican critic of the federal government, says a state exchange will involve fees for 177,000 expected participants that are estimated at a third of the federal cost.
Opponents, however, counter that the state has no idea what the plan would cost.
Sen. Bob Nonini, R-Coeur d'Alene and an insurance broker, said the governor's talk of protecting Idaho-based insurers such as Blue Cross of Idaho and Regence Blue Shield is misplaced. Lobbyists for both companies worked for the establishment of a state exchange.
Nonini said the companies are all flourishing, having accrued hundreds of millions of dollars in reserves while increasing the cost of premiums.
"We hear in debate that we're going to protect Idaho businesses by doing a state exchange," Nonini said. "These companies, whether they are insurers or those providing medical care, are doing quite well on their own."
Sen. Dean Cameron, R-Rupert, said the question isn't about the merits of Obama's Patient Protection and Affordable Care Act but rather what is the best way to adopt a key provision of the federal law over which Idaho has no control.
"This is a step forward - it's not just words on a paper - to protect Idaho citizens, Idaho consumers, Idaho jobs, to protect our rights as Idaho citizens so we don't acquiesce to the federal government," Cameron said.